Outline

Introduction: Chronic subdural haematoma (cSDH) is a common disease seen in neurosurgical practise, especially in elderly patients. This study intended to evaluate the peri-operative risks and outcome in elderly patients with chronic subdural haematoma.

Materials and methods: A retrospective analysis was performed by reviewing medical records. From 2002 to 2009 399 cases treated with burr hole craniostomy and closed-system drainage were evaluated with respect to cause of haemtoma, symptoms, concomittant diseases, surgical complications, recurrent incidents and outcome (KPS and mRS) at discharge of patients. Patients were divided into three groups regarding to age; (I): 65–74, (II): 75–84, (III): 85–94.

Results: The analysis revealed trauma as the major cause for cSDH. At the time of diagnosis, 37% (I), 40.6% (II) and 52.8% (III) of patients were treated with anticoagulant drugs. Patients in (I) mainly suffered headache (33,7%) and hemiparesis (29,8%), whereas patients in (II) reported hemiparesis (38,2%) and aphasia (14,5%). The patients in (III) suffered primarily hemiparesis (34%) and aphasia (30,2%). Predominant concomittant diseases were hypertension (I) and (II) followed by coronary artery disease (II) and (III). The incidence rate of surgical complications was 6,5% (I), 7,0% (II), 9,5% (III). The recurrent incidence rate was 21.5% (I), 27.3% (II) and 7.5% (III). The outcome measured by KPS before suffering cSDH/with cSDH/at discharge after treatment of cSDH was 90/80/90 (I), 80/70/80 (II) and 80/50/70 (III).

Conclusion: Burr hole trepanation is safe in elderly patients despite higher rates of anticoagulation and multimorbidity. At discharge patients belonging to group I and group II are able to acquire the same KPS level as before the event of cSDH, whereas patients in group III show a decreased KPS level. As a consequence a careful approach and postoperative monitoring is of great importance especially in the elderly patients.